Chest radiographs (CXRs) are the most common imaging investigations undertaken because of their value in evaluating the cardiorespiratory system. They play a vital role in intensive care units for evaluating the critically ill. It is therefore very common for the radiologist to encounter tubes, lines, medical devices and materials on a daily basis. It is important for the interpreting radiologist not only to identify these iatrogenic objects, but also to look for their accurate placement as well as for any complications related to their placement, which may be seen either on the immediate post-procedural CXR or on a follow-up CXR. In this article, we discussed and illustrated the routinely encountered tubes and lines that one may see on a CXR as well as some of their complications. In addition, we also provide a brief overview of other important non-cardiac medical devices and materials that may be seen on CXRs.

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Chest radiographs of cardiac devices (Part 1): Lines, tubes, non-cardiac medical devices and materials.

Mould infections may follow traumatic injuries, with direct fungal inoculum in the site of injury and subsequent angioinvasion, possibly resulting in tissue necrosis and systemic dissemination. The pathogenesis of mould infections following trauma injuries presents unique features compared with classical mould infections occurring in neutropenic or diabetic patients, because a large fraction of post-traumatic mould infections is observed in previously healthy individuals. Most of the published clinical experience and research on mould infections following traumatic injuries regards soldiers and infections after natural disasters. However, following trauma and soil contamination (e.g., agricultural or automotive injuries) other immunocompetent individuals may develop mould infections. In these cases, delays in correct diagnosis and treatment may occur if pertinent signs such as necrosis and absent or reduced response to antibacterial therapy are not promptly recognized. Awareness of mould infections in at-risk populations is needed to rapidly start adequate laboratory workflow and early antifungal therapy in rapidly evolving cases to improve treatment success and reduce mortality.

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Mould Infections of Traumatic Wounds: A Brief Narrative Review.

Insertion and postinsertion care of enteral nasogastric feeding tubes are common procedures in the United States, with more than 1.2 million temporary nasogastric feeding tubes inserted annually. Although there are some evidence-based practice guidelines and recommendations for care of these tubes, variation in practice still exists. Additional research is needed to determine the best methodology for insertion and confirmation of nasogastric feeding tubes. Routine competency and training on feeding tube insertion, enteral nutrition, and postinsertion care is crucial to prevent patient safety events. Variable results have been reported with different technologies; however, radiographic confirmation remains the criterion standard. It is important that health care institutions develop standardized procedures for insertion and confirmation on the basis of evidence-based practices to minimize risks and complications from temporary nasogastric feeding tubes.

Placement of Nasogastric Feeding Tube and Postinsertion Care Review.

Abstract Mucormycosis is a deadly fungal disease mainly caused by Rhizopus oryzae (strain 99–880), also known as Rhizopus delemar. Previously, mucormycosis occurs in immunocompromised patients of diabetes mellitus, cancer, organ transplant, etc. But there was a drastic increase in mucormycosis cases in the ongoing COVID-19 pandemic. Despite several available therapies and antifungal treatments, the mortality rate of mucormycosis is about more than 50%. Currently, there is no vaccine available in the market for mucormycosis that urgently needs to develop a potential vaccine against mucormycosis with high efficacy. In the present study, we have screened 4 genome-derived predicted antigens (GDPA) through sequential filtration of the whole proteome of R. delemar using different benchmarked bioinformatics tools. These 4 GDPA along with 4 randomly selected experimentally reported antigens (ERA) were sourced for prediction of B- and T- cell epitopes and utilized in designing of two potential multi-epitope vaccine candidates which can induce both innate and adaptive immunity against R. delemar. Besides these, comparative immune simulation studies and in silico cloning were performed using L. lactis as an expression system for their possible uses as oral vaccines. This is the first multi-epitope vaccine designed against R. delemar through systematic pipelined reverse vaccinology and immunoinformatic approaches. Although the wet-lab based experimental validation of designed vaccines is required before testing in the preclinical model, the current study will significantly help in reducing the cost of experimentation as well as improving the efficacy of vaccine therapy against mucormycosis and other pathogenic diseases. Communicated by Ramaswamy H. Sarma

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Screening of potential antigens from whole proteome and development of multi-epitope vaccine against Rhizopus delemar using immunoinformatics approaches

Objetivo: conhecer os eventos adversos relacionados a insercao, manutencao e remocao de sonda enteral descritos na literatura. Metodo: trata-se de uma revisao integrativa de literatura. A estrategia PICO foi utilizada para formulacao da questao norteadora. Foram selecionados artigos das bases PubMed, Embase e Scopus, publicados entre junho de 2009 e junho de 2019, nas linguas portuguesa, espanhola e inglesa. Resultados: foram incluidos 45 estudos, categorizados em eventos adversos relacionados a insercao da sonda enteral (n=22) que promoveram danos como epistaxe por lesao ate a insercao de sonda no atrio direito; eventos relativos a manutencao da sonda e/ou administracao de dieta (n=14), como a infusao de dieta em sitio pulmonar; e aqueles ocorridos na remocao (n=9), como emaranhado na ponta distal. Conclusao: diferentes eventos adversos descritos na literatura podem ocorrer na insercao, manutencao, administracao de dieta e remocao da sonda enteral. Descritores: Intubacao Gastrointestinal. Cuidados de Enfermagem. Nutricao Enteral. Seguranca do Paciente. Potencial Evento Adverso na Assistencia a Saude.

https://cienciasmedicasbiologicas.ufba.br/index.php/enfermagem/article/download/33850/20650

Eventos adversos relacionados à sonda enteral: revisão integrativa

Invasive fungal wound infection in an otherwise healthy trauma patient (Mucor Trauma).

BACKGROUND Dobhoff tube insertion is a common procedure used in the clinical setting to deliver enteral nutrition. Although it is often viewed as an innocuous bedside procedure, there are risks for numerous complications such as tracheobronchial insertion, which could lead to deleterious consequences. We present to our knowledge the first reported case of bilateral pneumothoraces caused by the insertion of a Dobhoff tube. In addition, we also discuss common pitfalls for confirming the positioning of Dobhoff tubes, as well as risk factors that can predispose a patient to improper tube placement. CASE REPORT We present the case of a 74-year-old male patient with multiple orthopedic injuries following an auto-pedestrian collision. Five attempts were made to place a Dobhoff tube to maintain enteral nutrition. Follow-up abdominal x-ray revealed displacement of the Dobhoff tube in the left pleural space. After removal of the tube, a follow-up chest x-ray revealed iatrogenic bilateral pneumothoraces. Acute hypoxemic respiratory failure ensued; therefore, bilateral chest tubes were placed. Over the next three weeks, the patient's respiratory status improved and both chest tubes were removed. The patient was eventually discharged to a skilled nursing facility. CONCLUSIONS Improper placement of Dobhoff tubes can lead to rare complications such as bilateral pneumothoraces. This unique case report of bilateral pneumothoraces after Dobhoff tube placement emphasizes the necessity of using proper diagnostic techniques for verifying proper tube placement, as well as understanding the risk factors that predispose a patient to a malpositioned tube.

Whitney Wilson

Papers

Invasive fungal wound infection in an otherwise healthy trauma patient (Mucor Trauma).

Bilateral Pneumothoraces in a Trauma Patient After Dobhoff Tube Insertion.